Spontani nestanak nefunkcionalnog adenoma hipofize u mjesec dana: prikaz slučaja

Spontaneous resolution of nonfunctioning pituitary adenoma after hemorrhagic apoplexy is a rare clinical entity of unknown etiology and is defined as disappearance of a tumor without any specific treatment. Here we present a 54-year-old male patient who presented with acute onset of severe headache, vomiting, photophobia, and sonophobia. He was referred to brain computed tomography, which showed a 16x12x16 mm tumor mass located in the sellar region with signs of hemorrhage. Endocrinologic evaluation was consistent with under-function of pituitary gonadotropic cells. Magnetic resonance imaging (MRI) performed ten days later was consistent with hemorrhagic apoplexy of the pituitary adenoma. The patient’s symptoms resolved after conservative treatment with dexamethasone, but he was scheduled for elective pituitary surgery. Preoperative MRI was performed one month after the first one and disclosed normal pituitary gland without any signs of adenoma. Our case is remarkable due to the fact that spontaneous remission of pituitary adenoma occurred within the first month, which is the shortest interval reported to date. Our case highlights the importance of conservative therapy as the first-line treatment for pituitary apoplexy in the absence of neurological impairment, since spontaneous remission may occur in a short time interval.Spontana regresija nefunkcionalnog adenoma hipofize nakon hemoragijske apopleksije je iznimno rijedak klinički entitet nepoznate etiologije, a definiran je kao nestanak tumora bez primijenjenog liječenja. Naš 54-godišnji bolesnik prezentirao se izrazito jakom, naglo nastalom glavoboljom, povraćanjem, fotofobijom i sonofobijom. Bolesnik je upućen na hitnu kompjutoriziranu tomografiju mozga koja je pokazala selarnu tumorsku tvorbu 16x12x16 mm sa zonom krvarenja. Endokrinološki nalazi upućivali su na disfunkciju gonadotropnih stanica hipofize. Nakon deset dana učinjena je magnetska rezonanca (MR) kojom je potvrđena hemoragijska apopleksija adenoma hipofize. Simptomi su se povukli nakon primijenjene konzervativne terapije deksametazonom, ali je bolesnik zakazan za kiruršku resekciju adenoma. Prijeoperacijski MR učinjen mjesec dana nakon prvoga pokazao je normalnu hipofizu bez znakova adenoma. Posebnost našega slučaja je vrijeme manje od mjesec dana u kojem se dogodila spontana remisija, što je najkraće dosad opisano vrijeme u svjetskoj literaturi. Naš slučaj naglašava važnost konzervativne terapije kao prve terapijske linije kod apopleksije adenoma hipofize u bolesnika bez neuroloških deficita i to upravo zbog činjenice što je spontana remisija moguća u kratkom vremenskom intervalu nakon pojave samih simptoma